MAHONING VALLEY Prescribing made safer by computers

The computer can cross-check to see if a new prescription would interact badly with another drug the patient is taking. By WILLIAM K. ALCORN VINDICATOR HEALTH WRITER WARREN -- Forum Health, Humility of Mary Health Partners and Salem Community Hospital are taking steps to improve patient safety by developing computerized drug prescription systems in their hospitals. The system, called Computer Physician Order Entry or CPOE, enables doctors to prescribe drugs via computer rather than writing them on paper and the chance of their being misread. Doctors would access the computer with hand-held computers or regular terminals. Once the prescription is in the information system, the computer can, with the proper software program, automatically cross-check to see if the new prescription would interact badly with another drug the patient is taking, or if the patient has a known allergy to the new drug. About the coalition: Hospital patient safety, along with the quality, cost and access to medical care, is a prime concern of Lake to River Health Care Coalition, located in Warren and affiliated with the General Motors/United Autoworkers/International Union of Electrical Workers Community Health Care Initiatives. Formed in 1987, Lake to River's goals coincide with the Leapfrog Group, a coalition of more than 90 public and private organizations that provide health-care benefits. The whole issue of patient safety was brought to the fore by a 1999 study by the Institute of Medicine, which said up to "98,000 Americans die each year from preventable medical mistakes during hospitalizations," said Jack Roberts, executive director of Lake to River. The mistakes are most often caused by systems that break down and don't support the highly qualified hospital caregivers the way they should, Leapfrog says. Although Lake to River has the general goal of patient safety, it chose as its first initiative in that area a review of preventable medication errors, Roberts said. Nationally, CPOE has been shown to avoid 522,000 medication errors and reduce serious prescribing errors in hospitals by 50 percent, Roberts said. Who's in review: Three major hospital systems in the counties served by Lake to River -- Forum Health, HMHP and Salem Community -- agreed to participate in a Lake to River review, which was initiated last spring and summer. The hospital systems also agreed to update the coalition periodically on these and other patient safety related issues, Roberts said. The coalition is planning follow-up visits with the hospitals this spring, he said. Three hospitals in the four-county area served by the coalition did not participate in the review -- East Liverpool City Hospital, Brown Memorial Hospital in Conneaut, and Ashtabula County Medical Center, Roberts said. When Lake to River first met with participating hospitals last year, hospital officials said they were aware of the main criteria outlined in the IOM report, and were in various stages of developing computer systems for prescribing medications at their institutions, Roberts said. At Forum Health, for instance, a task force was working on CPOE. "We are working this year to put the infrastructure in place and to get Forum Health physicians participating in the design of and comfortable with, the computer order entry system for pharmacy," said Kris Hoce, Forum Health president and chief executive officer. "This initiative must be physician-driven, and we believe it will be an essential part of our new patient care information system. We will be piloting the system in our intensive care units, where patients with more complicated conditions, require more diverse medications," Hoce added. Local efforts: HMHP's efforts regarding a computerized system which will meet the goals of the Leapfrog Group have been under way for more than a year. The hospital system has pharmacy interaction systems in place and integrated information systems for their two locations, Roberts said. St. Elizabeth Health Center, Youngstown, and St. Joseph Health Center, Warren, are in the HMHP system. At Salem Community Hospital, a computer program is in place that screens each medication order received in the hospital pharmacy. If negative drug interaction is possible, the computer program alerts the pharmacist, who in turn notifies the physician. The prevention of medication errors always will be a focus of the hospital's Continuous Quality Improvement program, said Michele Hoffmeister, Salem Community's director of public relations. In the developmental stage at SCH are a bar-coding system, as well as new computer terminal ports to be installed in the ICU. Under a bar-coding system, patients would wear a bar-code on their wrist band, making it easier to check against charts and medications. Also, an Internet system is being developed to assure accuracy of prescriptions and alert pharmacists of improper dosages. The hospital has installed clinical pathways by diagnosis to help standardize care and guide the treatment of a number of common diagnoses, Hoffmeister added. The hospitals are looking at the issue with somewhat different plans, but they are all positive, Roberts said. "We look at hospitals as allies," Roberts continued. "The big thing now is to get physicians to prescribe drugs some other way than by hand. In some cases, it might take a mandate from the hospital administration." Roberts said that local health care is probably a microcosm of the national picture. But, he noted, there might not be a problem locally, and the Lake to River review may show that. alcorn@vindy.com